Provider Demographics
NPI:1306485164
Name:PETERS, KIMBERLY S (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:PETERS
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6915 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:CASTLE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1822
Mailing Address - Country:US
Mailing Address - Phone:210-341-1487
Mailing Address - Fax:
Practice Address - Street 1:6915 WEST AVE
Practice Address - Street 2:
Practice Address - City:CASTLE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78213-1822
Practice Address - Country:US
Practice Address - Phone:210-450-9100
Practice Address - Fax:210-450-6009
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143710363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX430817301Medicaid
TX430817302OtherCSHCN